Provider Demographics
NPI:1194047316
Name:FISHER, ROBERT THEODORE JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THEODORE
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1921 SILVERNAIL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5596
Mailing Address - Country:US
Mailing Address - Phone:262-542-4700
Mailing Address - Fax:262-542-7499
Practice Address - Street 1:1921 SILVERNAIL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5596
Practice Address - Country:US
Practice Address - Phone:262-542-4700
Practice Address - Fax:262-542-7499
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4590-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor